Department of Medicine (Neurology), University Health Network, University of Toronto, Toronto, Ontario, Canada.
Ann N Y Acad Sci. 2012 Dec;1275:1-6. doi: 10.1111/j.1749-6632.2012.06767.x.
Intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) are used to treat myasthenia gravis (MG) but with little trial evidence. While a class I study provided evidence for the efficacy of IVIG treatment, the empirical support for PLEX has been less convincing until recently. In a randomized controlled single-masked study of 84 MG patients with moderate to severe disease, IVIG and PLEX had comparable efficacy as demonstrated by reduction in the Quantitative Myasthenia Gravis Score (QMGS) for disease severity, percentage of responders, persistence of treatment effect, and tolerability, which were similar in both treatment arms. The change in QMGS was accompanied by improved disease-specific quality of life. The only factor predicting response to treatment was baseline severity. FcR polymorphisms did not predict response to IVIG therapy, but an inhibitory polymorphism was associated with baseline disease severity. These studies support the choice of either IVIG or PLEX as comparable treatments in adult patients with moderate to severe MG.
静脉注射免疫球蛋白 (IVIG) 和血浆置换 (PLEX) 用于治疗重症肌无力 (MG)，但临床试验证据有限。虽然一项 I 类研究提供了 IVIG 治疗疗效的证据，但 PLEX 的经验性支持直到最近才更有说服力。在一项针对 84 例中重度 MG 患者的随机对照单盲研究中，IVIG 和 PLEX 的疗效相当，表现在疾病严重程度的定量重症肌无力评分 (QMGS) 降低、应答者比例、治疗效果持续时间和耐受性方面，在两种治疗组中均相似。QMGS 的变化伴随着疾病特异性生活质量的改善。唯一预测治疗反应的因素是基线严重程度。FcR 多态性不能预测 IVIG 治疗的反应，但抑制性多态性与基线疾病严重程度相关。这些研究支持在中重度 MG 成年患者中选择 IVIG 或 PLEX 作为等效治疗。
